HomeMy WebLinkAboutCROSS VIEW ESTATES BLK 2 LT 14Cross View
Estates
Block 2
Lot 14
#015-221-76
1a91° 77
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-' On-Site Water and Wastewater Pre$.t.m APR 21 2011 I .&i I I
(907)343-7904 °- s F ETT
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Certificate of On-Site Systems Ap. -10va s a r
Parcel I.D. 015-221 76-000 Expiration Date: g^2- f %�
1. GENERAL INFORMATION
Complete legal description Cross View Estates, Block 2, Lot 14
Location (site address) 5612 Heritage Heights Drive Anchorage, AK 99516
Current Property owner(s) Edward & Katherine Lightwood Day phone 440-6741
Mailing address 4640 E. 112th Avenue Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Five
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: /.I/i1/Milli i1 ' Q Date:5 /7
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5.24 Waiver Fee $
Date of Payment �/ /17 Date of Payment
Receipt Number t 'C? Receipt Number
COSA# (L5C1q ll5V Waiver#
5. STATEMENT OF INSIrErAWN BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation. . •
Name of Firm Anderson Engineering Phone 522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 4/26/2017
$ 49TH "\ *%��r
6. DSD SIGNATURE ..•• ... .o.. •t'
System #1 Approved for bedrooms `'
fir"°.•JhICiAEI- E.-ANDERSON °Fa
System #2 Approved for bedrooms , f•. CE-4381 .'
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Disapproved Fa. G •
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#441 Rpm t sc
Conditional approval for bedrooms, with the following.stipulation
OF ANC:/
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By: ,i " �� Original Certificate Date: Z?— /7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
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7. ATTACHMENTS: . ,. •
COSA Checklist X Nitrate Advispry
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet r :- .. c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Cross View Estates, Block 2, Lot 14 Parcel ID:015-221-79
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (YIN) Y
Date completed 10-27-13 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 254 ft. Cased to 254 ft. Casing height(above ground) >18 in.
FROM WELL LOG AT INSPECTION
Date of test 10-27-13 4-18-17
Static water level 219 ft. 197.3 ft.
Well production 12 g.p.m. 6.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate d.46 mg/L
Arsenic 0 ug/L Date of sample: 4/26/17 Collected by: Anderson Engrg.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/7/13
Tank size 1 500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping 4 ! g 117 Pumper k 1400`.6 SGQ-dh 5
C. ABSORPTION FIELD DATA
Date installed 9/7/13 Soil rating (g.p.d./ft2 or ft'/bdrm) .6 GPD/SF System type Deep Trench
Length 2 @ 40 ft Width 3 ft. Gravel below pipe 8 ft.
Total depth 12-13 ft. Eff. absorption area 1,280 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 4-18-17 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test 95/9,5 in. Water added 751 gal. New depth 19/20.5 in.
Elapsed Time: 1 ,440 min. Final fluid depth 9'5!9.5 in. Absorption rate >=_750 g.p.d.
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on"level at in. "Pump off"level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 7100 On adjacent lots X100'
Absorption field on lot 100' On adjacent lots 100'
Public sewer main >75' Public sewer manhole/cleanout 7100'
Sewer/septic service line 725 Holding tank 775'
Animal containment areas >50' _ Manure/animal excrete storage areas 100'
SEPTIC/HOLDING TANK ON LOT TO:
>5' 5' '
Building foundation Property line Absorption field
>100'
Water main 10Water service line 7 Surface water
Wells on adjacent lots >100'
ABSORPTION FIELD���� ON LOT TO:
Property line %� L r Building foundation >10' Water main >10'
>10'
Water Service line >10Surface water 100 Driveway, parking/vehicle storage
Curtain drain None Noted Wells on adjacent lots 7100'
F. COMMENTS
LU1 LAW, yiP RIE2 Ot-I Fid
G. ENGINEER'S CERTIFICATION `stiVIANII
/ certify that / have determined through field inspections and ar�'`�'..�F''.�.:(1. ..
review of Municipal records that the above systems are in a. �.. ..i.:„.10
conformance with MOA COSA guidelines in effect on this date. :x ::, °91- .':,, 00
•Engineer's Printed Name
Michael E. Anderson, P.E. �'•••• ) :•44• • 01
Date goi
4/24/2017 030 .MICHAEL E• . ANDERSON
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COSA brown sheet 10-10-12.doc